<!DOCTYPE html>
<html>
<title>Submit CGI</title>
<style>
    input[type="text"] {
        display: block;
        margin-bottom: 15px;
    }
    
    input[type="submit"] {
        padding: 6px 4px;
    }
    
    label {
        display: inline-block;
        float: left;
        width: 100px;
    }
    
    .clearfix {
        clear: both;
    }
    
</style>
<body>
	<form method="post" action="http://localhost/acv_sam/transaction/cgi" target="_blank">
		<label style="margin-bottom: 15px">Result</label>
		<input type="radio" name="result" value="success" checked="checked">Success
		<input type="radio" name="result" value="failure">Failure
		<div class="clearfix"></div>
		
		<label>Site Code</label>
		<input type="text" name="site_code" value="A019000063">
		
		<label>Order Code</label>
		<input type="text" name="order_code" value="<?php echo rand(1, 10000)?>">
		
		<label>Amount</label>
		<input type="text" name="amount" value="190%2e80">
		
		<label>Currency</label>
		<input type="text" name="currency" value="USD">
		
		<label>User ID</label>
		<input type="text" name="user_id" value="1">
		
		<label>Email</label>
		<input type="text" name="email" value="tucq88%40gmail%2ecom">
		
		<label>Telephone</label>
		<input type="text" name="telephone_no" value="65906679888">
		
		
		<label></label> 
		
		
		<input type="submit" value="Submit">
	</form>
</body>
</html>